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Safety of Conscious Sedation for Cardiology Procedures at Auckland Hospital
Abstracts Abstracts
remain. Clinicians should be aware of these differences when multi-modality imaging is used for therapeutic decision making. http://dx.doi.org/10.1016/j.hlc.2012.03.114 Implantable Cardioverter Defibrillator (ICE) Use in Hypertrophic Cardiomyopathy—Ten-Year Auckland Experience J. White ∗ , S. Sinclair, F. Riddell, M. Hood, N. Lever, W. Smith Electrophysiology Team, Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand Background: ICD use to prevent sudden cardiac death (SCD) in patients with Hypertrophic Cardiomyopathy (HCM) is well established. This review sought to define indications and assess the incidence of appropriate therapy and device-related complications, including inappropriate shocks. Methods: Patients were cross-coded for an echocardiographic diagnosis of HCM and ICD therapy and clinical records retrospectively reviewed. Results: Between 2002 and 2012, 59 HCM patients (39 male, ages 10–69 years) received an ICD for indications listed in Table 1. Forty-four (75%) patients received a transvenous and 15 (25%) a subcutaneous device. Patients were followed up for 221.4 patient-years (median 3.0 years). Ten patients (17%) received 1–8 appropriate shocks and 12 received 1–4 inappropriate shocks as summarised in Table 2. Atrial fibrillation/flutter occurred in 15 (25%) patients. There were 17 device-related complications in 14 patients. Nine patients had elective generator replacement and two devices were explanted. Three patients underwent car-
Table 1. Indications for ICD implantation. Secondary prevention Cardiac arrest Sustained ventricular tachycardia Primary prevention Syncope Non-sustained ventricular tachycardia Septal thickness ≥3 cm Family history SCD Other
14 (24%) 13 1 45 (76%) 12 (27%) 14 (31%) 27 (60%) 8 (18%) 2 (4%)
Table 2. ICD therapy.
Primary Secondary
Appropriate
Inappropriate
4/45 (9%) 6/14 (43%)
10/45 (22%) 2/14 (14%)
523
diac transplantation and 55/59 (93%) patients were alive at follow-up. Conclusion: Patient outcome for the whole group was good but the low incidence of appropriate shocks for primary prevention suggests case selection criteria remain suboptimal. Patients in this group also have a high incidence of inappropriate shocks. Rates of appropriate device therapy in secondary prevention implants were high. http://dx.doi.org/10.1016/j.hlc.2012.03.115 Safety of Conscious Sedation for Cardiology Procedures at Auckland Hospital J. White ∗ , A. Martin, N. Lever Electrophysiology Team, Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand Background: The combination of intravenous midazolam and fentanyl is routinely administered to provide conscious sedation in the course of pacemaker implants (PPM), percutaneous coronary interventions (PCI) and electrophysiology procedures (EPS) at Auckland Hospital. EPS might require higher doses of sedation due to procedure duration and other factors. The purpose of this series was to assess the safety of sedation and the need for anaesthetic support during these procedures. Methods: We report the sedation requirements and clinical outcomes of 100 consecutive PPM, PCI and EPS at Auckland Hospital. Results: The median dose (range) of midazolam administered for PPM was 1 mg (0–5), for PCI 1 mg (0–2) and for EPS 2 mg (0–12). The median dose (range) of fentanyl administered for PPM was 50 (0–175), for PCI 50 (0–200) and for EPS 50 (0–300). No PPM or PCI patients received more than 5 mg midazolam while seven EPS received more than 5 mg. Two EPS required use of a reversal agent. One urgent PCI required general anaesthesia for cardiogenic shock. Patients were discharged from hospital within 24 h of 74 PPM, 57 PCI and 95 EPS. Conclusion: A significant number of EPS require higher doses of sedation than other procedures with low rates of adverse events. Although safe, the adequacy of such sedation remains unclear and requires further study. http://dx.doi.org/10.1016/j.hlc.2012.03.116
ABSTRACTS
Heart, Lung and Circulation 2012;21:480–526
remain. Clinicians should be aware of these differences when multi-modality imaging is used for therapeutic decision making. http://dx.doi.org/10.1016/j.hlc.2012.03.114 Implantable Cardioverter Defibrillator (ICE) Use in Hypertrophic Cardiomyopathy—Ten-Year Auckland Experience J. White ∗ , S. Sinclair, F. Riddell, M. Hood, N. Lever, W. Smith Electrophysiology Team, Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand Background: ICD use to prevent sudden cardiac death (SCD) in patients with Hypertrophic Cardiomyopathy (HCM) is well established. This review sought to define indications and assess the incidence of appropriate therapy and device-related complications, including inappropriate shocks. Methods: Patients were cross-coded for an echocardiographic diagnosis of HCM and ICD therapy and clinical records retrospectively reviewed. Results: Between 2002 and 2012, 59 HCM patients (39 male, ages 10–69 years) received an ICD for indications listed in Table 1. Forty-four (75%) patients received a transvenous and 15 (25%) a subcutaneous device. Patients were followed up for 221.4 patient-years (median 3.0 years). Ten patients (17%) received 1–8 appropriate shocks and 12 received 1–4 inappropriate shocks as summarised in Table 2. Atrial fibrillation/flutter occurred in 15 (25%) patients. There were 17 device-related complications in 14 patients. Nine patients had elective generator replacement and two devices were explanted. Three patients underwent car-
Table 1. Indications for ICD implantation. Secondary prevention Cardiac arrest Sustained ventricular tachycardia Primary prevention Syncope Non-sustained ventricular tachycardia Septal thickness ≥3 cm Family history SCD Other
14 (24%) 13 1 45 (76%) 12 (27%) 14 (31%) 27 (60%) 8 (18%) 2 (4%)
Table 2. ICD therapy.
Primary Secondary
Appropriate
Inappropriate
4/45 (9%) 6/14 (43%)
10/45 (22%) 2/14 (14%)
523
diac transplantation and 55/59 (93%) patients were alive at follow-up. Conclusion: Patient outcome for the whole group was good but the low incidence of appropriate shocks for primary prevention suggests case selection criteria remain suboptimal. Patients in this group also have a high incidence of inappropriate shocks. Rates of appropriate device therapy in secondary prevention implants were high. http://dx.doi.org/10.1016/j.hlc.2012.03.115 Safety of Conscious Sedation for Cardiology Procedures at Auckland Hospital J. White ∗ , A. Martin, N. Lever Electrophysiology Team, Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand Background: The combination of intravenous midazolam and fentanyl is routinely administered to provide conscious sedation in the course of pacemaker implants (PPM), percutaneous coronary interventions (PCI) and electrophysiology procedures (EPS) at Auckland Hospital. EPS might require higher doses of sedation due to procedure duration and other factors. The purpose of this series was to assess the safety of sedation and the need for anaesthetic support during these procedures. Methods: We report the sedation requirements and clinical outcomes of 100 consecutive PPM, PCI and EPS at Auckland Hospital. Results: The median dose (range) of midazolam administered for PPM was 1 mg (0–5), for PCI 1 mg (0–2) and for EPS 2 mg (0–12). The median dose (range) of fentanyl administered for PPM was 50 (0–175), for PCI 50 (0–200) and for EPS 50 (0–300). No PPM or PCI patients received more than 5 mg midazolam while seven EPS received more than 5 mg. Two EPS required use of a reversal agent. One urgent PCI required general anaesthesia for cardiogenic shock. Patients were discharged from hospital within 24 h of 74 PPM, 57 PCI and 95 EPS. Conclusion: A significant number of EPS require higher doses of sedation than other procedures with low rates of adverse events. Although safe, the adequacy of such sedation remains unclear and requires further study. http://dx.doi.org/10.1016/j.hlc.2012.03.116
ABSTRACTS
Heart, Lung and Circulation 2012;21:480–526